This is a blog by a former CEO of a large Boston hospital to share thoughts about hospitals, medicine, and health care issues.

Tuesday, September 10, 2013

Oh good. More expensive AND no benefit.

A story from Robert Langreth at Bloomburg, based on a scientific study. Excerpts:

Surgery to remove the uterus using
a $1.5 million robot from Intuitive Surgical Inc. (ISRG) doesn’t reduce
complications and may raise pneumonia risk compared with
conventional less-invasive techniques, according to a second
extensive study to find no added benefit from the devices.

Researchers examined data from about 16,000 women who had
hysterectomies for benign conditions in 2009 and 2010. The robot
operations cost hospitals $2,489 more per procedure with a
similar complication rate as the standard practice of removing
the uterus with minimally invasive equipment, according to the
study released in the journal Obstetrics & Gynecology.

The results released yesterday are from the second large-scale research published this year to find higher costs with no
added benefit for robotic hysterectomy.

In February, a study in the Journal of the American Medical
Association found that robotic hysterectomies for benign
conditions cost hospitals $2,189 more per procedure than the
same surgery without the robot. That research, which looked at
data from 441 hospitals from 2007 to 2010, showed complication
rates were 5.5 percent for the robot surgery and 5.3 percent for
a less invasive hysterectomy.

The response from Intuitive. Regular readers will recognize it as a variant on, "Our patients are sicker."

Intuitive Surgical, in an e-mail, said patients in the
study getting robotic surgery tended to be older, heavier and
had a higher rate of chronic conditions.

4 comments:

The study is an RCT, so how are the robotic surgery patients older and sicker? This whole issue is ridiculous, and symptomatic of everything wrong with our system today. The fact that there is so little pressure to remove any public dollars from reaching these groups is an indication that there is no political will to enact any REAL health reform that will address affordability of care for fear of public and lobbyist backlash.

I think we have to look closely at how these fads, and they ARE fads, get started in medicine in the first place. Recruitment by the vendor, with financial incentives, of a cadre of either gullible or voracious/ambitious physicians to help push the technology, when added onto hospital administrators' equally voracious competitive instincts, lead to a kind of tidal wave of adoption before anyone knows what has happened. Just ask Paul about how he was more or less forced to buy a robot at his hospital despite his own misgivings.

I think a good part of the underlying problem here relates to the cost plus reimbursement mentality that dates to the earliest days of the Medicare program. Indeed, the term “reimbursement” implies a sum that covers all legitimate costs, including the cost of capital. By contrast, the term “payment” suggests a negotiated sum for value received which may or may not cover the provider’s fully allocated costs.

Just because a new drug, device or procedure wins FDA approval does not mean that taxpayers or commercial insurers should have to pay for it no matter how much it costs. This is an important reason why we need reference pricing in these kinds of situations. If a procedure requiring the use of an expensive piece of equipment is paid for at the same rate as a more cost-effective established approach, maybe hospitals wouldn’t be so quick to buy the new, expensive equipment no matter how hard rainmaker surgeons clamor for it.

Interestingly the true benefit from these robots may not be to the patient, the hospital, the ACO or the insurance company. The true benefit is to the surgeon and their practice longevity.Look at obstetricians - how many develop hand related injuries? How many are actually disabled from hand-related injuries? The numbers are climbing in direct proportion to the obesity rate. The fatter we get as a population, the more injuries our surgeons suffer. Robotic assistants improve our ability to provide care to our population by reducing the disability rate among surgeons.